Hemodialysis Program Research Articles

Does the hemodialysis program affect the prostate-specific antigen (PSA) serum levels in patients with end-stage renal disease (ESRD)? A cross-sectional descriptive study.

This study aims to investigate the effect of high-flux membrane hemodialysis on total prostate-specific antigen (tPSA) serum levels in hemodialysis patients and to evaluate the clinical significance of any observed changes. A cross-sectional descriptive study was conducted involving 75 hemodialysis patients at An-Najah National University Hospital. tPSA and hematocrit (Hct) serum levels were measured before and after one hemodialysis session. The correlation between changes in tPSA and Hct levels was analyzed using the Statistical Package for Social Sciences (SPSS). The mean age of the patients was 54.25 ± 15.27 years, with a mean hemodialysis duration of 40 ± 38 months. The mean tPSA levels before and after hemodialysis were 0.95 ± 0.81 ng/ml and 1.15 ± 0.96 ng/ml, respectively. Significant increases were observed in both tPSA (t = -3.264, p = 0.002) and Hct levels (t = -7.861, p < 0.001). The percentage changes in tPSA and Hct were 20% and 12%, respectively, with no significant correlation between the changes (r = 0.152, p = 0.215). Hemodialysis significantly elevates tPSA serum levels; however, no significant correlation was found between changes in tPSA and Hct. None of the patients showed clinically significant elevations in tPSA that would necessitate prostate biopsy. Therefore, high-flux membrane hemodialysis does not appear to compromise the diagnostic value of tPSA in hemodialysis patients.

Does the hemodialysis program affect the testosterone serum level in patients with end-stage renal disease?

This study aimed to evaluate the effect of high flux membrane hemodialysis on total serum testosterone (TST) levels in male patients with end-stage renal disease (ESRD). The study included 60 male ESRD patients with a mean age of 54.02 ± 13.40years, undergoing a standard hemodialysis program et al. Najah National University Hospital. All patients underwent three weekly sessions of four hours each using high flux membrane hemodialysis. TST and hematocrit (Hct) levels were measured before and after hemodialysis. Patients with prostate cancer, liver insufficiency, prior prostate surgery, or those on androgen therapy were excluded. The study assessed changes in TST and Hct levels and their correlation. Post-dialysis, there was a significant increase in serum testosterone levels from 3.13 ± 1.44ng/ml to 4.17 ± 2.04ng/ml (r = 0.78, p = 0.001). Hematocrit levels also rose significantly from 32.31% ± 3.90% to 35.27% ± 4.89% (r = 0.754, p = 0.001). The percentage change in TST and Hct levels was 35 ± 0.33% and 9 ± 0.1%, respectively, with a correlation between these changes (r = 0.277, p = 0.032). High flux membrane dialysis did not filter testosterone molecules, and the significant increase in TST levels post-dialysis is likely due to hemoconcentration. Since many patients had low or borderline TST levels before dialysis, androgen supplementation may offer clinical benefits.

C-Reactive Protein-to-Serum Chloride Ratio: A Novel Marker of All-Cause Mortality in Maintenance Haemodialysis Patients

Background and Objectives: hypochloremia is an emerging risk factor for mortality in patients with chronic kidney disease. The pathophysiological mechanisms of this finding are not very clear. Some studies suggest the influence of inflammation as a synergistic factor, so we set out to analyse the association of a novel C-reactive protein-to-serum chloride ratio (CRP/Cl−) with the prognosis of maintenance haemodialysis patients and to assess its relationship with fluid status and body composition measured by bioimpedance. Materials and Methods: the present work is a retrospective cohort study of maintenance haemodialysis patients from our chronic outpatient haemodialysis programme between 1 January 2022 and 31 December 2022. (n = 281). Survival time was collected for all patients and analysed using the Kaplan–Meier method. A Cox proportional hazards regression model was used to evaluate survival probabilities. Variables included in the model were selected using a stepwise selection procedure based on the corrected Akaike information criterion (AICc), which balances model fit and complexity. Results: during a median follow-up of 306 days, 34 patients died. Patients in the fourth quartile of the CRP/Cl− (&gt;0.118 mg/mEq) had higher overall mortality (log-rank test, p = 0.0011). In the Cox multivariate analysis, the variables significantly associated with higher mortality were higher modified Charlson index (MCI), lower body surface area (BSA), lower interdialytic weight gain (IDWG), and higher CRP/Cl− ratio. The latter variable was independently associated with higher overall mortality (adjusted hazard ratio = 1.027; 95% confidence interval [CI], 1.000–1.055 p = 0.0469). Conclusions: Higher CRP/Cl− ratio values were associated with higher all-cause mortality in our maintenance haemodialysis patients.

Psychosocial factors affecting the adherence of chronic kidney disease patients to undergo a hemodialysis program: a cross-sectional study

Introduction: This study aims to analyze the effect of psychosocial factors on hemodialysis program adherence. Methods: The study was cross-sectional, with a sample size of 90 respondents, obtained through simple random sampling. The study’s dependent variable was hemodialysis program adherence and the independent variables were knowledge, motivation, coping, depression, perceived family support and health worker support. Data were collected using a questionnaire and analyzed using multiple linear regression. Results: Most respondents adhered to the hemodialysis program (90%). The level of knowledge, motivation, coping, family support, and health worker support was in the good category (93.3%; 100%; 91.1%; 90%; 88.9%, respectively), and did not experience depression (90%). The independent variables (knowledge, motivation, coping, family support, health worker support) simultaneously significantly affected the dependent variable, namely adherence to the hemodialysis program by 94.5% (R2 = 0.945; F = 236.613; p = 0.001). Partially, the factors of knowledge, motivation, coping, family support, health workers support, and depression also had a significant effect on hemodialysis program adherence (t = 2.234, t = 5.344, t = 3.473, t = -4.190, t = 6.457, t = 4.887, t = 4.190, respectively; p = 0.001). Conclusions: The study results showed that psychosocial factors (knowledge, motivation, coping, family support, health worker support, and depression) simultaneously or partially influenced the adherence of CKD patients to undergo a hemodialysis program, with the most dominant factor affecting adherence to hemodialysis as perceived family support. Keywords: Adherence, Hemodialysis, Psychosocial

Fragilidad del adulto mayor con enfermedad renal crónica. Un estudio observacional de centro único

Introduction: Frailty in the elderly (AM) increases morbidity and mortality. This condition is highly prevalent in Chronic Kidney Disease (CKD) and, together with frailty, greatly affects physical, cognitive, and emotional capacity. The study aimed to determine frailty in older adults with CKD in a reference center in Cuenca-Ecuador. Methods: The present observational study was conducted at the “José Carrasco Arteaga” Hospital from September 2020 to April 2021. Older adults with a diagnosis of CKD were included; patients with disabilities, severe cognitive impairment, and those with palliative care were excluded. The direct source variables are demographic, clinical, physical activity, functional capacity, mood, mental state, and frailty. The sample was probabilistic. The Chi2 test is used to compare percentages. Results: 79 cases are analyzed. The MA had 38% frailty, 36.7% were pre-frail, and 25.3% were robust. A more significant proportion of 'young' AM was observed in patients classified as robust. A more substantial proportion of robust patients were receiving clinical treatment, while patients in the hemodialysis program were classified as frail. The most significant proportion of robust patients had mild degrees of renal failure, while frail patients were classified as CKD grades 4 and 5. Physical activity was active primarily in robust patients and mostly passive in patients with frailty. Conclusion: Conclusion: there is a high prevalence of frailty in this population group, especially in women and those between 75 and 85 years old. The results suggest that CKD in older adults is associated with a higher risk of frailty, dependence, and comorbidities, which underlines the importance of implementing multidisciplinary and personalized interventions to improve the quality of life and prognosis of these patients.

MiRNAs and indicators of mineral metabolism in the population of dialysis patients

Introduction. Cardiovascular events are the leading cause of death in patients on renal replacement dialysis therapy. The vast majority of patients with CKD 5D have left ventricular hypertrophy (LVH), which is a predisposing factor to diastolic dysfunction, heart failure (HF), arrhythmias, and sudden cardiac death. In recent years, a significant role in the development of cardiovascular pathology in CKD has been attributed to disturbances in calcium and phosphorus homeostasis. Mineral bone correction may have a beneficial effect on LVH.Aim. To evaluate the associations between indices of mineral-bone metabolism and cardiac echocardiography parameters in patients on renal replacement therapy (RRT) with hemo- and peritoneal dialysis, receiving and not receiving phosphate binders.Materials and methods. The study included 75 patients, of whom 53 received treatment with program hemodialysis (HD), 22 with peritoneal dialysis (PD). The control group consisted of 28 healthy volunteers. 43 patients were treated with phosphate binders. Of all patients receiving treatment aimed at correcting hyperphosphatemia, 22 received sevelamer carbonate: 86% of patients took sevelamer carbonate at a dose of 4800 mg/day and 14% at a dose of 2400 mg/day. All biochemical parameters were determined on an automatic biochemical analyzer; FGF-23 was also determined by enzyme-linked immunosorbent assay (ELISA) and the level of intact PTH was determined by chemiluminescence immunoassay. Instrumental studies included echocardiography.Results. In patients with left ventricular hypertrophy (LVMM in the group of patients on hemodialysis 206.6 [120.0; 300.0], in the group on peritoneal dialysis 176.2 [134.0; 204.0]) the level of FGF-23 was significantly increased (p = 0.005). In the group of patients receiving sevelamer carbonate, there was a decrease in the incidence of left ventricular hypertrophy, lower levels of FGF-23 (12.4 ± 5.9), in contrast to the group that did not receive this drug (23 ± 7.3; p = 0.003 ) and PTH (110 ± 27 ng/ml, in the group that did not receive the drug – 340 ± 15; p = 0.01).Conclusions. The use of phosphate binders, in particular sevelamer carbonate, is associated with a decrease in left ventricular hypertrophy and lower levels of FGF-23.

Clinical signifi cance of various variants of euthyroid pathology syndrome in patients with end-stage chronic kidney disease on programmed hemodialysis

The number of patients with end-stage renal disease (ESRD) is growing every year. Due to the high comorbidity of such patients, the search for factors that influence the course of the disease and outcome is of particular importance. Indications for studying the functional state of the thyroid gland, as well as recommendations for the treatment of thyroid dysfunction in patients with ESRD have not been developed.THE AIM: to study indicators of thyroid status and identify clinically significant variants of the euthyroid pathology syndrome in patients with ESRD on program hemodialysis (PHD).PATIENTS AND METHODS. The study included 123 patients with ESRD undergoing PHD. A cross-sectional study was conducted to examine thyroid function parameters in patients with ESCKD undergoing PHD. All patients were assessed for the levels of thyroidstimulating hormone (TSH), free triiodothyronine (free T3) and free thyroxine (free T4), the comorbidity index, which was calculated using the Charlson scale, the effectiveness of program hemodialysis using Kt/V, and the urea reduction coefficient (URR).RESULTS. Increased TSH levels were associated with higher body mass index in the studied patients. “Low T3” syndrome is associated with older age and high comorbidity. The high level of T4 in the examined patients is also associated with old age, high comorbidity and a KT/V index below the target values.CONCLUSION. The TSH level in patients with endstage renal insufficiency on programmed hemodialysis does not reflect the true functional state of the thyroid gland.

Incremental hemodialysis and vascular access complications: a 12-year experience in a hospital hemodialysis unit.

Incremental hemodialysis (HD) is considered a valid alternative for patients with residual kidney function. Evidence concerning its effect on vascular access is scarce. We present our 12-year experience of an incremental hemodialysis program with the aim of evaluating survival and complications of arteriovenous fistula in these patients compared to the thrice-weekly scheme. From January 1st, 2006 to December 31st, 2017, 220 incident patients startedhemodialysis, 132 (60%) of whom began hemodialysis with two sessions per week and 88 (40%) with three sessions per week. Demographic and clinical variables were assessed at the start of treatment. Data regarding arteriovenous fistula survival and complications were collected. Both groups had similar baseline sociodemographic and clinical characteristics. A total of 188 (85%) patients were dialyzed with an arteriovenous fistula during follow-up. Eighty-three patients had one or more fistula complications, with no differences between incremental and conventional groups (p = 0.55). Fistula survival rates showed no significant difference between the two groups, whether analyzed from the date of fistula creation (Log Rank p = 0.810) or from the date of initial fistula cannulation (Log Rank p = 0.695). We found no differences in arteriovenous fistula survival or complication rate between patients who started HD with an incremental versus a conventional treatment scheme. Randomized controlled clinical trials may be warranted to achieve a higher degree of evidence.

Correlation of plasmatic sodium determined by the laboratory and that determined by the dialysis machine

IntroductionChanges in plasma sodium concentration (pNa, expressed in mEq/L) are common in hemodialysis (HD) patients. Hemodialysis monitors can estimate pNa by using an internal algorithm based on ion dialysance measurements. The present study studies the accuracy of the correlation between the pNa estimated by the dialysis monitor and that measured by the biochemistry laboratory at our center. Material and methodsA single-centre prospective observational study in patients on a chronic HD program with the 6008 CAREsystem monitor and standard sodium (138mmol/L) and bicarbonate (32mmol/L) prescriptions. Venous blood samples were drawn from each patient before and after each HD session to ensure inter- and intra-individual validity. The pNa was measured in the biochemistry laboratory using indirect potentiometry and simultaneously the estimated pNa by the HD monitor was recorded at the beginning and at the end of the HD session. For statistical analysis, a scatterplot was made, and Spearman’s correlation quotient was calculated. In addition, the differences between both methods were represented as Bland-Altman diagrams. ResultsThe pre-dialysis pNa measured in the laboratory was 137.49±3.3, and that of the monitor, 137.96±2.91, with a correlation with R2 value of 0.683 (p<0.001). The post-dialysis pNa measured in the laboratory was 137.08±2.23, and that of the monitor was 138.87±1.88, with an R2 of 0.442 (p<0.001). On the Bland-Altman plots, the pre-dialysis pNa has a systematic error of 0.49, in favor of the monitor-estimated pNa, with a 95% confidence interval (CI) of (−3.24 to a 4.22). In the post-dialysis pNa, a systematic error of 1.79 with a 95% CI of (−1.64 to 5.22) was obtained. ConclusionThe correlation between the pNa estimated by Fresnius 6008 CAREsystem HD monitor and that measured by the laboratory is good, especially pre-dialysis measurements. Further studies should verify the external validity of these results.

#2826 The Charlson Comorbidity Index in Registry-Based Research for Survival of Vascular Access

Abstract Background and Aims Several studies have reported higher haemodialysis survival in women; however, the influence of gender on arteriovenous fistula survival has not been extensively studied. For this reason, our aim is to estimate the prevalence of arteriovenous fistulae according to gender, adjusted by the Charlson comorbidity index. Method Retrospective study in patients on haemodialysis programme, by consulting electronic records over a period of 35 months. Demographic variables, primary and secondary patency events were included. The population was categorised on the basis of the Charlson Index and gender. Statistical analysis was performed using Kaplan Meyer survival curves to contrast the impact of comorbidities on the different patency events. Results 52 patients were evaluated, with a mean age of 70.7 ± 1.57 years, 69.2% men, 30.8% women, 42.3% diabetic, Charlson with a median of 7 (6.5 - 7.73), 98.1% had a native fistula, being more frequent the location in the humeral head (63.5%) and predominantly in the left upper limb (65.4% ). 21.2% of patients required some intervention on their AVF. The time required to achieve an event in both primary patency and secondary patency was longer in patients with a Charlson Index less than or equal to 7, and this was statistically significant (Log Rank Test (Mantel-Cox): primary patency p=0.003 and secondary patency p=0.002). In the group of women with a Charlson comorbidity index less than or equal to 7, mean survival for primary and secondary patency was even higher than in all patients, with statistical significance (Log Rank Test (Mantel-Cox ): primary patency p=0.005 and secondary patency p=0.008), a situation not repeated in men where no significant differences in survival were found when analysed according to the Charlson index. Conclusion The Charlson index in our population is a significant factor in the survival of AVFs in women.

#2833 Charlson comorbidity index predicts early failure and overall survival of vascular access among diabetic dialysis patients.

Abstract Background and Aims Vascular access (VA) survival is a determinant factor in the morbidity and mortality of haemodialysis patients, directly influencing their quality of life. Some studies have described the influence of diabetes on the reduced survival of arteriovenous fistulas as an independent factor; however, the correlation between other comorbidities in diabetic patients with vascular access survival has been less well documented. Therefore, our aim is to describe the relationship between comorbidities in diabetic haemodialysis patients and arteriovenous fistula (AVF) patency. Method Descriptive, observational and retrospective study in prevalent patients included in a haemodialysis programme by consulting electronic records over a period of 35 months. Demographic variables; related to vascular access and primary and secondary patency of all accesses were included. The Charlson Comorbidity Index was used to categorise diabetic patients according to comorbidities. Kaplan Meyer survival curves were used to contrast the impact of comorbidities on the different patency. Results 22 patients, mean age 68.36 ± 10.9 years, 68.18% male, 31.82% female, Charlson index with a median of 6.5 (5 - 8), 95.45% had a native fistula, with humero-cephalic location being more frequent (72.72%) and predominance of the left upper arm (68.18%). The time required to reach an event in both primary patency and secondary patency in diabetic patients was longer in patients with a Charlson index less than or equal to 7, this being statistically significant (Log Rank Test (Mantel-Cox): primary patency p=0.022 and secondary patency p=0.032). Conclusion The Charlson Comorbidity Index in our population is a significant factor in arteriovenous fistula survival.

#1986 Incidence of renal anemia among patients with atrial fibrillation and chronic kidney disease stage IIIb-V

Abstract Background and Aims According to the QICKD study, the prevalence of anemia in stage IIIb-V chronic kidney disease (CKD) is 22%. The incidence of renal anemia ranges from 8.4% in patients with stage I CKD to 83.7% in patients with stage V CKD. In patients on program hemodialysis, anemia develops in 94.5% of cases. The problem is associated with an increased risk of unfavorable outcome of CKD, therefore, the study of aspects of anemia among patients receiving anticoagulant therapy with atrial fibrillation (AF) and CKD remains the most relevant today. The purpose of the study is to study the prevalence of renal anemia among patients with AF and CKD stages IIIb-V. Method 794 patients were admitted to the cardiology department with a diagnosis of AF and late stages of CKD—IIIb (glomerular filtration rate (GFR) 45–30 ml/min/1.73 m2), IV (GFR 29–15 ml/min/1.73 m2), V (GFR &amp;lt;15 ml/min/1.73 m2), for the first identified sustained decrease in glomerular filtration rate (FISD in GFR) of less than 45 ml/min/1.73 m2. The classification of renal anemia was carried out according to the recommendations of the World Health Organization. Results Renal anemia was diagnosed in 505 (63%) patients with AF and GFR less than 45 ml/min/1.73 m2. In total, among patients with CKD stage IIIb, anemia was detected in 207 (59%) patients, with CKD stage IV—in 110 (89%), with CKD stage V—in 43 (97%), with FISD in GFR—in 145 (51%). A mild degree of anemia (hemoglobin (Hb) in men 110-129 g/l, in women 110-119 g/l) was diagnosed in 39% of patients, with CKD stage IIIb in 85 (24%) patients, with CKD stage IV in 28 (22%) patients, with CKD stage V in 9 (20%) patients, with FISD in GFR in 75 (26%) patients. A moderate degree of anemia (Hb 81-109 g/l) was detected in 47.3% of cases, with CKD stage IIIb in 86 (25%) patients, with CKD stage IV in 60 (48%) patients, with CKD stage V in 29 (66%) patients, with FISD in GFR in 64 (23%) patients. Severe anemia (Hb 81-109 g/l) was detected in 47.3% of patients, with CKD stage IIIb in 36 (10%) patients, with CKD stage IV in 22 (19%) patients, with CKD stage V in 5 (11%) patients, with FISD in GFR in 6 (2%) patients. Conclusion Every fourth patient in the cardiology department with AF and GFR &amp;lt;45 ml/min/1.73 m2 was diagnosed with renal anemia, and its prevalence increases with a decrease in GFR. The above results indicate that a more careful selection of anticoagulant therapy is recommended for this patient population due to the high risk of progression of renal anemia in this cohort of patients.

#2131 Difelikefalin in the management of pruritus associated with chronic kidney disease (Pa-CKD) in hemodialysis: Results from Andalusia

Abstract Background and Aims Pruritus associated with chronic kidney disease (CKD-aP) is a debilitating and common symptom in patients with chronic kidney disease on hemodialysis, with a prevalence of moderate to severe pruritus around 40–45%. The pathogenesis is not yet fully understood. It has been formally attributed mainly to abnormal levels of uremic toxins. The most recent data indicate a significant role for the dysregulation of the kappa opioid receptor (KOR) along with an imbalance in the mu-opioid receptor (MOR). Difelikefalin (DFK) is a KOR agonist approved for the treatment of moderate to severe CKD-aP in patients on hemodialysis in the USA, European Union (EU), Switzerland, Canada, Singapore, and Australia. It has shown rapid and sustained improvement in pruritus and is generally very well tolerated. Method We present the real-world experience of DFK in an early access program for patients in a hemodialysis (HD) program three times a week, diagnosed with CKD-aP, receiving the administration of DFK at 0.5 mcg/kg per HD session. A total of 14 HD patients with severe to very severe CKD-aP (WI-NRS &amp;gt;7) and (moderate-severe SADS) were treated with DFK. The severity of itching was assessed using the numerical rating scale (WI-NRS). Quality of life was assessed using the Self-Assessed Disease Severity Score (SADS). Results The results are shown in Table 1. 78.5% of the patients showed a reduction in WI-NRS of at least 3 points within the first 2 weeks and 92% showed a reduction of ≥ 5 points at 4 weeks, with positive effects on the patients' quality of life, describing a change from SADS C (severe deterioration of quality of life) to SADS A (mild deterioration). Conclusion Currently, 11 out of the 14 patients continue with Difelikefalin and maintain a sustained response in both itch intensity and quality of life. The availability of this new treatment, along with a new understanding of the impact of pruritus on our patients, has the potential to significantly improve the lives of patients living with CKD-aP. Sharing the clinical experience of DFK in series like this is important to raise awareness, not only of DFK but also of CKD-aP, particularly in the absence of specific treatments.

#926 Qatar's Assisted Home Hemodialysis Program (AHHD): a new challenge to reach better outcomes for elderly patients

Abstract Background and Aims There are a growing number of patients supported by dialysis in older age. In Qatar, 58% of haemodialysis patients are above 60 years. The dialysis care of these patients can be challenging due to frailty, chronic health conditions, diminished QOL, and function. One important reason to favor Assisted Home Haemodialysis (AHHD), especially in the older population is the greater flexibility in conducting dialysis sessions. Our aim is to assess the efficacy of AHHD program in comparison to in-center dialysis. Method This is retrospective study to evaluate AHHD program in Qatar between July 2021 to December 2023 and compare to in-center haemodialysis in complications, compliance, infectivity and cost. Results The AHHD population increased gradually to 122 patients in December 2023. Patients and families reported great satisfaction 98.9% with the AHHD experience as they reported less fatigue post dialysis, eliminated the burden of transportation, and improved quality of life by having HD provided in a home environment. AHHD patients had a significantly lower infection rate (5%) during the COVID-19 outbreak than those receiving in-center dialysis. AHHD freed up crucial slots in hemodialysis centers, increasing the availability of dialysis slots by 10%. Mortality rate was 20.6% while 5 % of patient returned back to in-center dialysis. No major clinical or technical complications had been reported during follow up. The program had resulted in 25% reduction in total cost mainly due to reduction in ambulance use. Conclusion AHHD service increases access to hemodialysis care for elderly patients. The AHHD in Qatar showed great success over 30 months and there was a remarkable increase in the number of patients who started the AHHD with better outcomes regard to QOL and infectivity. It was cost-effective and showed an obvious outcome of reducing ambulance transport utilization and improving patients’ QOL and satisfaction.

#2967 C-reactive protein/serum chloride ratio: a novel marker of all-cause mortality in prevalent chronic haemodialysis patients

Abstract Background and Aims Serum chloride (Cl-) is an emerging marker of mortality in hypertension, sepsis, heart failure and chronic kidney disease. The pathophysiological mechanism is unclear, but haemodynamic and inflammatory factors have been suggested. As C-reactive protein (CRP) is an established marker of inflammation and prognosis in haemodialysis patients, we sought to determine whether there is an association between the CRP/Cl- ratio and prognosis in these patients. Method Retrospective cohort study. We included n = 281 prevalent patients in our chronic haemodialysis programme between 19 January 2022 and 11 August 2022. The mean follow-up was 10 months. The sample was divided into quartiles according to CPR/Cl— ratio values. Baseline demographic, analytical and bioimpedance data were collected (Table 1). Survival time was recorded in all patients and analysed using the Kaplan-Meier method. Results The median CPR/Cl— ratio was 0.04 mg/mEq (0.02; 0.12). Women accounted for 31.8%. 28.9% had underlying diabetic nephropathy. Overall survival at 10 months was 87.9%. Patients who died had a higher CPR/Cl— value [0.12 (0.04; 0.19)] vs [0.04 (0.02; 0.10)] (p = 0.0005). In addition, those in the fourth quartile had a lower probability of survival compared to the other quartiles (p = 0.0011, log-rank test) (Fig. 1). Conclusion Higher values of the CPR/Cl index were associated with higher all-cause mortality in our sample of prevalent haemodialysis patients.

#1487 Preoperative ultrasound vascular mapping as a predictor of arteriovenous fistula survival: a prospective cohort study

Abstract Background and Aims The morbidity and mortality of hemodialysis (HD) patients is directly related to the vascular access (VA) type. The arteriovenous fistula (AVF) is considered the VA of choice. When compared to the use of catheter, the use of AVF encompasses a lower infectious complications rate and a higher survival rate. The use of catheter has been independently associated with an increased risk of morbidity and mortality, especially during the first year of treatment. It is essential that HD programs maintain a high incidence and prevalence of AVF as a VA. For that reason, a multidisciplinary management is mandatory, with the collaboration of nephrologists, vascular surgeons, radiologists, and nurses. All patients who have an indication of AVF should have a prior ultrasound vascular mapping performed by the nephrologist to determine the most appropriate type of AVF. According to guidelines, there are several factors that increase the risk of AVF failure including advanced age, history of smoking, diabetes mellitus and peripheral vascular disease, among others. Therefore, the aim of this study is to determine the benefits of performing a preoperative ultrasound vascular mapping in terms of AVF survival. The secondary objective is to associate some risk factors to a higher rate of AVF failure. Method We conducted a prospective cohort study between January 2020 and December 2023. The viability of AVF was compared between AVF resulting from a preoperative ultrasound vascular mapping and those AVF without previous mapping. A multivariate analysis was performed with the entire population to determine the factors related to AVF survival. Results This study analyzed a total of 136 AVF, both native and prosthetic. Our population included 106 patients, mostly men (69.79%), with a median age of 68 years old (IR: 56-76), and history of smoking in a 39.10%, of diabetes in a 42.43%, and of peripheral vascular disease in a 17.54%. A preoperative ultrasound vascular mapping was previously performed in 107 AVF (78.7%). A total of 93 AVF were functional (68.4%). Regarding the analyzed risk factors of AVF failure (including advanced age and history of smoking, diabetes mellitus and peripheral vascular disease, and elbow/wrist AVF), we observed that advanced age and elbow AVF were related to higher survival of the AVF (p = 0.048 and p = 0.01 respectively). In the multivariate analysis we observed that advanced age and elbow AVF were independent predictors of AVF survival (p = 0.038 and p = 0.001, respectively). When comparing the cohorts, in the AVFs were the preoperative vascular ultrasound was performed, 78 AVF were functional (72.9%). In the AVFs were no mapping was performed, 15 AVF were functional (51.7%). This difference was statistically significant (p = 0.03). This implies a 21.2% increase in the probability of AVF survival when performing our AVF mapping. Conclusions The performance of a preoperative ultrasound vascular mapping by the nephrologist in our population has been associated to a significant increase in AVF survival. For that reason, we consider that it is an indispensable tool for the creation and monitoring of VA. When analyzing risk factors classically associated to AVF failure, we found that advanced age and elbow AVF were independent predictors of higher AVF survival. Other risk factors, such as history of diabetes mellitus, smoking, and peripheral arterial disease, were not significantly related to AVF failure in our population.

#2209 Hypoglycemia induced by hemodialysis in diabetic and non-diabetic patients, how to prevent it? A prospective study

Abstract Background and Aims Hemodialysis-induced hypoglycemia, a documented complication associated with adverse clinical outcomes, including mortality, is linked to factors such as impaired gluconeogenesis, inadequate nutritional status, reduced insulin clearance, glucose loss to the dialysate, and autonomic neuropathy. Glycemic variability is recognized as an independent risk factor for morbidity and mortality. This study aims to investigate the incidence of hypoglycemia during hemodialysis (HD) by exploring protocol-related factors and their impact, such as in-nutrition during HD. Additionally, the study seeks to examine the relationship between nutritional and inflammatory statuses and variations in intradialytic glycemia in both diabetic and non-diabetic patients. Method This prospective study, conducted between September and December 2023, examined the glycemic profiles of HD patients at a hospital HD program. All patients undergo hemodialysis with a dialysate containing 100 mg/dL of glucose. Plasma glucose levels were assessed at the start, 2:30 hours post-initiation, and the end of sessions. Following the 2:30-hour mark, patients received a meal (523 Kcal). Glycose variability was computed by averaging blood glucose differences across all sessions. Data collected included demographics, hemodialysis specifics, and lab results. Inflammatory and nutritional statuses were evaluated using lab tests at the study's beginning and conclusion [ferritin, protein C reactive (PCR), interleukin 6 (IL-6) and albuminemia, urea, creatinemia, cholesterol, respectively]. Anthropometric measurements and bioimpedance assessments were performed, with values averaged for better representation. Categorical variables are shown with frequencies/percentages, and continuous variables with means/standard deviations or medians/interquartile ranges for skewed distributions. The study used repeated measures ANOVA for glycemic profiles, correlation analyses for outcome influences on glycemia, and parametric/non-parametric tests for relations in diabetic and non-diabetic groups. Significance was set at p&amp;lt;0.05, analyzed with SPSS version 29 for Mac OS 13. Results 63 patients, 67.2% (n=43) were males, the medium age was 72.0±11.8 and 50.8% (n=32) had diabetes. Among 9072 measurements, hypoglycemia was observed in 0.07% (n=6) of diabetic patients and 0.01% (n=1) in non-diabetic individual. The initial blood glucose measurement was 139.5±260.0 mg/dL, the second was 117.05±35 mg/dL, and the third was 132.8±21.3 mg/dL. Significant differences were observed in all measurements [F (1.17, 73.58)=23.62; p&amp;lt;0.001]. The mean glycemic variation between the first and second measurements was 23.8±46.0 mg/dL, and for the third measurement was 5.5±71.5 mg/dL. There was no significant correlation found between glycemic and nutritional parameters neither between inflammatory parameters. In the subgroup analysis comparing diabetic and non-diabetic patients, the diabetic group demonstrated lower serum creatinine levels (6.8±2.7 mg/dL) and total cholesterol (137.4±35.6 mg/dL), coupled with a higher Charlson Index (8.2±1.7). These differences were statistically significant (p=0.055, p=0.035, p&amp;lt;0.001). In the subsequent analysis, no other statistically significant associations were observed. Conclusion Contrary to what is described in the literature, the studied population exhibited a very low incidence of hypoglycemic events. This underscores the importance of nutrition during HD, along with the use of a glucose-containing dialysate, as an effective preventive measure against intradialytic hypoglycemia. Careful consideration of these factors is warranted to prevent adverse health consequences for our patients. It is plausible that diabetic patients may face an elevated risk of malnutrition, necessitating heightened concern and a more proactive preventive approach.

#1440 Analysis of risk factors for the development of coronary events in patients with chronic kidney disease stage 5

Abstract Background and Aims To analyze the number and presence of certain risk factors for the development of coronary events in patients with chronic kidney disease receiving program hemodialysis. Method To achieve this goal, we first conducted an information search in electronic databases of articles: in English - in PubMed, the search depth was from 2010 to 2020, after which we selected the most common risk factors for the development of coronary events in the conditions of Uzbekistan (Table 1). The study and recruitment of patients took place in the department of nephrology and hemodialysis of the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation in 2023. The study involved 73 (42.95%) men and 97 (57.05%) women; the average age of the patients was 54.00 ± 13.72 years. The main causes of chronic renal failure in the structure of the overall morbidity of the prospective study were: diabetic nephropathy - 41% (69), chronic glomerulonephritis - 40% (68), chronic pyelonephritis - 12.9% (22). Results All 170 patients were assessed for risk factors for the development of coronary events according to Table 1. Based on the current literature, we selected 30 risk factors for the development of coronary events. The most common risk factors for the development of coronary events were, that is, 2/3: albumin, body mass index, calcium, cardiovascular diseases, clinical and ambulatory blood pressure, chronic heart failure, diastolic blood pressure, hemoglobin, left ventricular hypertrophy, mean arterial pressure, systolic blood pressure, diuretic (urea), years with hypertension. The least significant risk factors for the development of coronary events were, that is, 1/3: diabetes, diabetic nephropathy, dyslipidemia, coronary heart disease, left ventricular end-diastolic volume, metabolic syndrome, parathyroid hormone, peripheral vascular disease, phosphorus, potassium, pulse pressure, sodium (in plasma), sodium-potassium ratio, smoking, total cholesterol. Conclusion In 2/3 of the studied patients of the main group, the presence of 15 risk factors for the development of coronary events was noted, in 1/3 of the patients, 21 risk factors for the development of coronary events were identified. The above risk factors together increase the incidence of coronary events in patients with stage 5 CKD several times. Coronary events are the leading causes of death in all groups. The most common were: acute left ventricular failure and sudden cardiac death. And predictors of the risk factor for death for coronary events include: blood albumin levels, BMI, blood hemoglobin, LVH, SBP, DAS, CHF, blood calcium, years since hypertension.

A practical approach to implementing incremental haemodialysis.

The majority of end-stage kidney disease patients are treated with haemodialysis (HD). Starting HD can pose physical, social, and psychological challenges to patients, and mortality rates within the first 6 months are disproportionately high, with intensive HD regimens implicated as a potential factor. Starting HD with an incremental approach, taking residual kidney function (RKF) into account, potentially allows for a gentle start with reduced dialysis intensity. Dialysis intensity (session time or frequency) can then be proportionally increased as RKF reduces. This approach to starting HD has been reported in observational studies to result in better patient self-reported health quality of life and reduced costs, and now several definitive randomised controlled trials are underway comparing an incremental approach to the conventional thrice weekly paradigm. Physician concerns over the risk of inadequate dialysis, with consequent increased emergency admissions, and practical challenges of how to estimate RKF and implement incremental dialysis have impeded widespread adoption. Addressing these challenges is paramount to increasing the uptake of incremental HD. Careful patient selection lies at the heart of a successful incremental HD programme. Generally, patients with a residual urea clearance of > 3 ml/min/1.73 m2 can be considered suitable for starting with incremental HD provided they comply with fluid intake, salt and other dietary recommendations. Calculating RKF from regular interdialytic urine collections and appropriately adjusting sessional HD clearance targets are practical and conceptual challenges. In this report we aim to disentangle these complexities and provide a step-by-step guide for patient selection and adjusting dialysis sessional targets.

Impact of Ultrafiltration Profiling Compared to Conventional Methods on Blood Pressure Regulation Among Hemodialysis Patients

Background: Standard hemodialysis sessions pose challenges for patients due to fluctuations in blood pressure. Alternative strategies, such as ultrafiltration profiling, have been proposed as potentially more effective treatments. Objectives: This study aimed to evaluate the effects of ultrafiltration profiling compared to the conventional method on blood pressure regulation among hemodialysis patients. Methods: This study employed a pre-test and post-test design, involving a single group of 30 hemodialysis patients undergoing treatment at Shahid Beheshti Hospital in Hamadan in 2022. The sampling method used was simple random sampling. The intervention consisted of three sessions using the routine method, followed by three sessions utilizing the ultrafiltration profile method, which employed an interval with a negative slope. Demographic and clinical information about the patients was recorded on a checklist. Systolic and diastolic blood pressure measurements were taken before the commencement of hemodialysis, at 1-, 2-, and 3-hour intervals post-treatment initiation, and again 15 minutes after completing hemodialysis. Results: The mean blood pressure changes observed during dialysis stages increased with both methods; however, there was a significant difference between the methods (P &lt; 0.001). Specifically, patients receiving the ultrafiltration profile method experienced significantly lower increases in blood pressure compared to those receiving the routine method. Conclusions: Based on the research results, integrating ultrafiltration profiling into hemodialysis can be regarded as an effective and viable strategy for enhancing blood pressure regulation in patients undergoing hemodialysis treatment. Therefore, it is recommended that this approach be considered in hemodialysis programs as well.